A patient with primary hyperparathyroidism is found to have a single enlarged parathyroid gland on sestamibi scintigraphy. Intraoperatively, a 1.2 cm adenoma is excised and intraoperative PTH drops by more than 50% within 10 minutes. What does this indicate?
- A Residual hyperfunctioning gland remains
- B Successful adenoma removal with biochemical cure ✓
- C Multiglandular hyperplasia is present
- D Parathyroid carcinoma has been incompletely excised
Correct answer: B. Successful adenoma removal with biochemical cure
Explanation
The Miami criterion defines cure as a greater than 50% fall in intraoperative PTH within 10 minutes of adenoma excision. PTH has a short half-life of 3-5 minutes, so a rapid drop confirms complete removal of hyperfunctioning tissue. Failure to drop by 50% suggests a second abnormal gland. This intraoperative biochemical monitoring has enabled targeted minimally invasive parathyroidectomy to replace bilateral neck exploration in most cases.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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